of  js?t.  %onis 


§Ualttt  Qzpavttnsnt 


November  20th,  1895. 


In  submitting  this  pamphlet,  it  is  my  intention  to  give  to 
the  public,  in  a  plain  and  condensed  form,  the  sanitary  precau¬ 
tions  to  be  observed  in  contagious  diseases,  and  I  have  also 
included  the  rules  and  ordinances  enacted  by  the  Municipal 
authorities  to  govern  such  cases. 

I  earnestly  recommend  that  the  instructions  and  prevent¬ 
ive  measures  be  strictly  carried  out,  and  request  the  hearty 
co-operation  of  all  citizens  in  the  work  of  suppressing  contagious 
diseases. 


Health  Commissioner. 


DIPHTHERIA. 


1.  Where  hygienic  conditions  are  bad,  diphtheria  will  spread 
from  a  single  case  and  become  endemic  (confined  to  a  circum¬ 
scribed  locality)  or  epidemic  (prevailing  generally  in  a  com¬ 
munity).  The  malady  differs  in  intensity  from  the  mildest 
form,  which  resembles  a  simple  sore  throat,  to  the  worst  type  of 
blood-poisoning,  which  is  intractable  from  the  beginning. 

2.  How  the  Disease  is  Communicated. —  Diphtheria  is 
communicable  in  all  its  forms,  either  by  contagion  or  through 
the  medium  of  an  infected  atmosphere  ;  and  when  it  has  once 
broken  out  in  a  house,  it  is  liable  to  spread  through  the  air  of 
the  apartments,  especially  in  overcrowded  and  badly  ventilated 
habitations.  Children  are  much  more  liable  to  the  disease  than 
adults,  and  are  more  subject  to  its  violent  forms.  Adults  may 
have  it  so  lightly  as  not  to  be  aware  of  its  existence,  and  thus 
they  may  disseminate  it  ignorantly  among  children.  All  diph¬ 
theria  patients  and  persons  in  contact  with  them  should  be  con¬ 
sidered  dangerous,  and  should  not  associate  with  others  until  it 
is  decided  by  a  careful  and  intelligent  physician  that  they  can  do  so 
without  endangering  others.  This  applies  especially  to  children 
attending  schools,  churches,  or  assemblies  of  any  kind.  Persons 
in  intimate  contact  with  diphtheria  cases  are  very  liable  to  have 
the  bacillus  in  their  throat  secretion,  and  are  therefore  danger- 

7  O 

ous  members  of  the  community,  for  although  showing  no  symp¬ 
toms  of  the  disease  themselves,  may  be  the  means  of  trans¬ 
mitting  it  to  others.  The  disinfection  of  houses  before  it  is 
positively  ascertained  that  the  diphtheria  bacillus  is  entirely  ab¬ 
sent  from  the  throat  should  not  be  requested. 

3.  Active  Measures  of  Prevention. — These  consist  (1) 
in  avoiding  the  special  contagion;  (2)  in  avoiding  all  crowded 
assemblies  in  illy  ventilated  rooms  during  the  prevalence  of  the 
disease;  (3)  in  maintaining  thorough  cleanliness  of  person  and 
premises;  (4)  in  the  speedy  removal  of  all  vegetable  and  animal 
refuse  matters;  (5)  in  keeping  cellars  clean  and  dry;  (6)  in 
free  and  thorough  ventilation  of  dwellings,  especially  sleeping 


4 


apartments;  (7)  in  boiling  or  filtering  drinking  water  when 
there  is  any  suspicion  as  to  its  purity;  (8)  in  the  free  use  of 

disinfectants  in  all  places  where  foul  odors  may  arise. 

\  * 

4.  Kestrictive  Measures. — The  restrictive  measures  recom¬ 
mended  are:  (1)  Prompt  isolation  of  the  sick  from  the  well; 
(2)  restriction  of  nurses  in  their  intercourse  with  outside  per¬ 
sons  ;  (3)  keeping  the  sick  room  free  from  all  needless  clothing, 
carpets,  drapery,  etc.,  likely  to  harbor  the  poison  of  the  disease; 
(4)  a  liberal  supply  of  fresh  air  in  the  sick  room,  taking  care 
to  avoid  direct  draughts;  (5)  burning  or  thoroughly  disinfect¬ 
ing  and  burying,  remote  from  the  house  and  source  of  drinking 
water,  all  discharges  from  the  throat,  nose,  mouth,  kidneys  and 
bowels;  (6)  placing  soiled  bed  and  body  linen  in  boiling  water 
at  once,  or  in  water  containing  a  little  chloride  of  lime,  soda  or 
zinc,  or  wash  all  the  soiled  linen  and  bed  clothing,  as  well  as  the 
floors  of  the  rooms  where  the  disease  has  existed,  with  a  solution 
of  Bichloride  of  Mercury  (  Corrosive  Sublimate )  in  the  propor¬ 
tion  of  one  part  to  two  thousand;  (7)  disinfecting  the  rooms  in 
which  any  case  or  cases  of  diphtheria  have  occurred,  with  all  the 
contents,  by  exposure  for  several  hours  to  strong  fumes  of 
chlorine  gas  or  burning  sulphur,  and  subsequently  to  currents  of 
fresh  air  ;  (8)  no  public  funeral  should  be  held  in  a  house  in 
which  a  death  from  diphtheria  has  recently  occurred,  nor  in  a 
church  or  other  place  where  the  body  of  a  diphtheria  patient 
lies  dead;  (9)  the  bodies  of  those  who  have  died  of  diphtheria 
should  be  securely  wrapped  in  a  disinfected  cere-cloth — a  sheet 
saturated  in  a  solution  of  chloride  of  zinc,  hfilf  a  pound  of  the 
salt  to  a  gallon  of  water. 

5.  Careful  examination  of  all  plumbing  of  the  house,  first  as 
to  the  trapping  of  the  water-closets,  and  sinks  in  laundry  and 
kitchen,  ventilation  of  soil  pipes,  and  a  careful  examination  of 
all  plumbing  of  every  description  in  a  cellar  in  which  there  is  a 
furnace.  Where  there  are  no  sewer  connections,  the  vaults  in 
the  yard  should  be  kept  scrupulously  clean  and  well  disinfected. 

6.  Where  families  move  from  one  residence  to  another,  the 
house  into  which  they  move  should  be  well  fumigated  before  the 
furniture  is  moved  in.  If  they  have  had  diphtheria  in  the  house 
out  of  which  they  are  moving,  the  house  should  be  fumigated 

*  CT  7  O 

before  the  furniture  is  removed. 


5 


SCARLET  FEVER. 

Prevention  and  Restriction  of  Scarlet  Fever. 

Scarlet  Fever  is  a  highly  contagious  disease,  directly  com¬ 
municable  from  one  person  to  another,  or  by  infected  clothing, 
rags,  etc.,  or  by  the  discharge  from  the  body  of  a  person  sick 
with  the  disease.  It  is  always  attended  with  a  scarlet  eruption 
on  the  skin,  and  is  generally  accompanied  by  a  sore  throat. 
When  a  child  or  young  person  has  a  sore  throat  and  fever,  and 
especially  if  it  has  an  eruption  of  the  skin,  it  should  imme¬ 
diately  be  separated  and  kept  secluded  from  all  other  persons 
except  necessary  attendants,  until  it  be  determined  whether  or 
not  it  has  scarlet  fever,  or  sorge  other  communicable  disease. 

During  the  progress  of  this  disease,  not  only  the  eruption  of 
the  skin,  but  everything  that  is  thrown  off  from  the  body  of  the 
sick,  contains  the  germs  or  seeds  of  the  disease,  which  are 
capable  of  propagating  it  in  another  person.  The  discharges 
from  the  nose  and  throat  are  especially  dangerous.  The  secre¬ 
tions  from  the  kidneys,  which  are  frequently  seriously  affected 
in  scarlet  fever,  and  the  discharges  from  the  bowels,  are  also 
supposed  to  be  capable  of  spreading  the  poison,  and  this  power 
may  be  retained  for  a  long  time.  When  these  secretions  have 
found  their  way  into  cess-pools,  sewers,  heaps  of  decaying 
organic  matter,  etc.,  they  may  be  still  capable  of  giving  off  the 
poison  and  of  spreading  the  disease.  It  is,  therefore,  of  the 
greatest  importance  to  destroy  the  poison  before  it  leaves  the 
sick  room. 

Attendants  upon  persons  suffering  from  scarlet  fever,  and  also 
the  members  of  the  patient’s  family,  should  not  mingle  with 
other  people,  nor  should  children  be  allowed  to  enter  a  house 
in  which  this  disease  exists.  Children  not  believed  to  be  infected 
should  be  sent  away  from  the  house  in  which  scarlet  fever  exists, 
to  families  not  liable  to  the  disease ;  but  they  should  be  isolated 
from  the  public  for  at  least  fourteen  days  from  the  time  of  their 
removal.  Children  under  ten  years  of  age  are  in  much  greater 
danger  of  taking  the  disease,  and  after  they  do  take  it,  of  dying 
from  it,  than  are  grown  persons.  But  adults  sometimes  have 
the  disease,  and  even  though  it  be  in  a  mild  form,  they  may 
communicate  the  disease  in  fatal  form  to  children. 


6 


In  cases  of  scarlet  fever  the  following  directions  should  be 
carried  into  effect: 

1.  Have  the  patient  placed  in  one  of  the  upper  rooms  of  the 
house,  the  furthest  removed  from  the  rest  of  the  family,  where 
is  to  be  had  the  best  ventilation  and  isolation.  The  room  should 
be  instantly  cleared  of  all  curtains,  carpets,  woolen  goods  and 
all  unnecessary  furniture.  Keep  the  room  constantly  well  ven¬ 
tilated,  by  means  of  open  windows,  and  fires,  if.  necessary. 
Maintain  the  utmost  cleanliness  both  with  regard  to  the  patient 
and  in  the  room.  A  basin  charged  with  chloride  of  lime,  or 
some  other  efficient  disinfectant,  should  be  kept  constantly  on 
the  bed  for  the  patient  to  spit  in.  Change  the  clothing  of  the 
patient  as  often  as  needful,  but  do  not  carry  it  while  dry 
through  the  house.  A  large  vessel  (as  a  tub)  containing  a  solu¬ 
tion  of  carbolic  acid,  in  the  proportion  of  four  fluid  ounces  of 
clear  carbolic  acid  to  the  gallon  of  water,  or  a  solution  of 
chloride  of  lime,  in  the  proportion  of  half  an  ounce  of  the  best 
chloride  of  lime  to  the  gallon  of  water,  should  always  stand  in 
the  room,  for  the  reception  of  all  bed  and  body  linen  im¬ 
mediately  on  its  removal  from  the  person  or  contact  with  the 
patient.  Pocket  handkerchiefs  should  not  be  used,  but  small 
pieces  of  rag  should  be  employed  instead  for  wiping  the  mouth 
and  nose;  and  each  piece  after  being  once  used  should  be  im¬ 
mediately  burned.  Two  basins,  one  containing  a  solution  of  the 
purer  quality  of  carbolic  acid,  in  the  proportion  of  half  a  fluid 
ounce  to  the  quart  of  water,  or  of  chlorinated  soda,  in  the  pro¬ 
portion  of  two  fluid  ounces  to  the  quart  of  water,  and  the  other 
containing  plain  water  and  a  good  supply  of  towels,  must  always 
be  ready  and  convenient,  so  that  the  hands  of  the  nurse  may  be 
at  once  disinfected  and  washed  after  they  have  been  brought  in 
contact  with  the  patient.  All  glasses,  cups,  and  other  vessels 
used  by  or  about  the  patient,  should  be  scrupulously  cleansed 
before  being  used  by  others.  The  discharges  from  the  bowels 
and  kidneys  are  to  be  received  on  their  very  issue  from  the  body 
into  vessels  containing  some  disinfectant,  as  a  solution  of  four 
fluid  ounces  of  carbolic  acid  to  the  gallon  of  water,  or  of  four 
ounces  of  the  best  chloride  of  lime  to  the  gallon  of  water,  and 
immediately  removed.  No  person  should  be  allowed  to  enter 
the  room  except  those  who  are  necessarily  attending  upon  the 
sick.  A  sheet  moistened  with  a  strong  solution  of  carbolic  acid, 


7 


suspended  outside  the  door  of  the  room  or  across  the  passage¬ 
way  leading  to  it,  is  useful  to  complete  the  isolation  of  the 
patient. 

2.  Food  and  drink  that  have  been  in  the  sick  room  should 
be  at  once  destroyed  or  buried. 

3.  Do  not  kiss  a  person  who  has  a  sore  throat,  nor  take  his 
or  her  breath.  Do  not  drink  out  of  the  same  cup,  nor  use  any 
article  that  has  been  used  by  such  person. 

4.  Body  and  Bed  Clothing,  etc. — It  is  best  to  burn  all 
articles  of  small  value  which  have  been  in  contact  with  persons 
sick  with  scarlet  fever. 

5.  Cotton,  linen,  flannels,  blankets,  etc.,  should  be  treated 
with  the  boiling  hot  zinc  solution,  introducing  them  piece  by 
piece,  securing  thorough  wetting  and  boiling  for  at  least  half  an 
hour.  Heavy  woolen  clothing,  silks,  furs,  stuffed  bed  covers, 
beds  and  other  articles  which  cannot  be  treated  with  the  zinc 
solution,  should  be  hung  in  the  room  during  fumigation,  pockets 
being  turned  inside  out  and  the  whole  garment  being  thoroughly 
exposed.  Afterward  they  should  be  hung  in  the  open  air, 
beaten  and  shaken.  Carpets  are  best  fumigated  on  the  floor, 
but  should  afterward  be  removed  to  the  open  air  and  thoroughly 
beaten.  Pillows,  beds,  stuffed  mattresses,  upholstered  furni¬ 
ture,  etc.,  after  being  disinfected  on  the  outside,  may  be  cut 
open  and  their  contents  again  exposed  to  fumes  of  burning  sul¬ 
phur.  In  no  case  should  the  thorough  disinfection  of  clothing, 
bedding,  etc.,  be  omitted.  Infected  clothing  and  bedding  have 
been  known  to  communicate  scarlet  fever  months  after  their 
infection. 


8 


CONSUMPTION. 


Sometimes  called  “Tuberculosis,”  “Phthisis,”  “Phthisis  Pul- 
moualis,”  “Tubercular  Phthisis,”  “Tubercular  Con¬ 
sumption,”  or  “Pulmonary  Consumption.” 

Consumption  is  known  to  be  a  communicable  disease,  in 
which  frequently  the  contagium  is  carried  from  the  dried  sputum 
of  a  consumptive  to  the  lungs  of  a  susceptible  person,  where  it 
grows  and  multiplies  and  thus  produces  the  disease.  The  germ 
which  causes  consumption  is  called  the  bacillus  tuberculosis ,  and 
it  is  present  in  the  sputa  of  consumptives.  These  bacilli  are 
from  about  one  twenty-thousandth  to  one  ten-thousandth  of  an 
inch  in  length,  and  have  a  breadth  about  one-sixth  of  their 
length.  (From  1.5  to  3.5,  by  .4  micromillimeters.)  These 
bacilli  have  been  thoroughly  studied,  and  repeated  successful 
inoculations  have  been  performed  on  lower  animals.  Interest¬ 
ing  experiments  have  been  made  in  this  connection  by  Dr. 
George  Cornet,  of  the  Berlin  Hygienic  Institute,  with  the  dust 
of  rooms  inhabited  by  consumptives.  Dust,  collected  from  those 
surfaces  not  likely  to  be  contaminated  directly  by  the  spitting 
or  coughing  of  the  patient,  was  mixed  with  sterilized  bouillon 
and  injected  into  the  peritoneal  cavity  of  guinea  pigs.  Forty 
days  later  the  animals  were  killed,  and  a  careful  necropsy 
was  made.  Twenty-one  hospital  wards,  in  which  there  were 
consumptive  patients,  were  examined  in  this  way,  and  from  the 
dust  of  fifteen  of  them  tuberculosis  was  set  up  in  the  guinea 
pigs  experimented  upon.  Private  houses  where  consumptives 
lived  gave  similar  results ;  where  patients  had  been  in  the  habit 
of  expectorating  on  the  floor,  the  dust  from  the  walls  was  cer¬ 
tain  to  yield  infectious  cultures,  but  where  cloths  or  spittoons 
had  been  used  this  was  not  the  case. 

The  mode  of  communication  of  this  disease  is  mainly  from 
the  dried  sputa  from  consumptives.  The  germs  in  the  sputa 
are  carried  into  the  air  by  sweepings,  and  deposited  upon  walls 
or  contents  of  rooms,  or  find  their  way  to  the  lungs  of  persons. 

Destruction  of  Sputa. — It  is  evident  that  the  only  certain 
preventive  of  consumption  is  to  destroy  the  sputum  from  the 
consumptive  before  it  has  an  opportunity  to  dry  and  scatter  the 
seeds.  It  is  for  the  consumptive’s  own  safety  to  destroy  sputa, 


9 


because  it  reduces  to  a  minimum  the  possibility  of  re-infection. 
Any  person  who  has  a  habitual  cough,  and  raises  sputa,  should 
have  a  microscopical  examination  of  the  sputa,  to  ascertain 
whether  it  contains  the  bacillus  tuberculosis.  Without  waiting 
for  such  examination,  in  all  such  cases  the  sputa  should  be  dis¬ 
infected. 

The  consumptive  should  carry  small  pieces  of  cloth  (each 
just  large  enough  to  properly  receive  one  sputum)  and  paraffined 
paper  envelopes  or  wrappers  in  which  the  cloth,  as  soon  as  once 
used,  may  be  put  and  securely  enclosed,  and,  with  its  envelope, 
burned  on  the  first  opportunity. 

Destruction  of  the  Dejecta. — All  dejecta  of  a  consump¬ 
tive  person  should  be  destroyed  or  disinfected ;  because  it  has 
been  shown  that  the  bacilli  are  to  be  found  in  the  urine  of  per¬ 
sons  having  tubercular  diseases  of  the  urinary  organs,  and  in 
the  fasces  of  those  having  tubercular  diseases  of  the  bowels,  and 
they  may  exist  in  the  faeces  of  those  who  swallow  sputa  containing 
the  bacilli,  that  is,  possibly,  of  any  consumptive.  Disinfect 
each  discharge  from  the  bowels  by  thoroughly  mixing  with  it  at 
least  one  ounce  of  chlorinated  lime  in  powder. 

The  unwashed  clothing  of  a  consumptive  should  not  be  min¬ 
gled  with  the  unwashed  clothing  of  another  person  ;  care  should 
be  taken  that  the  handkerchiefs  be  boiled,  that  other  articles 
liable  to  harbor  the  bacilli  should  be  disinfected,  that  no  virus 
come  in  contact  with  a  cut  or  injured  hand. 

No  one  should  sleep  in  the  same  room  with  a  consumptive 
patient ;  or  in  a  room  which  has  been  occupied  by  a  consumptive, 
unless  the  room  has  been  previously  subjected  to  the  fumes  of 
burning  sulphur.  A  room  which  has  been  occupied  by  a  con¬ 
sumptive  person  may  well  (with  all  its  contents)  be  thoroughly 
disinfected,  first  subjecting  it,  for  twenty-four  hours,  to  strong 
fumes  of  burning  sulphur,  and  then  it  should  for  several  hours 
be  exposed  to  currents  of  fresh  air. 

Upon  application  to  the  Health  Commissioner ,  all  apart¬ 
ments  that  have  been  lately  occupied  by  cases  of  consumption,  will 
be  subjected  to  the  action  of  disinfectants ,  free  of  charge. 


10 


SHALL  POX. 

Small  pox  is  always  the  result  of  infection.  The  specific 
poison  which  is  the  cause  of  the  disease  is  very  active — a 
momentary  exposure  to  it  will  often  result  in  producing  small 
pox  in  the  unprotected,  and  the  vitality  of  the  infection,  under 
certain  circumstances,  is  capable  of  being  preserved  a  long 
time.  The  disease  is  dangerous  and  loathsome  in  the  extreme, 
giving  a  high  death  rate  in  the  unvaccinated,  and  hideously  dis¬ 
figuring  and  maiming  many  who  outlive  it. 

The  present  generation  from  its  own  observation  can  have  no 
adequate  conception  of  the  terrible  devastation  which  this  dis¬ 
ease  caused  before  the  discovery  of  vaccination.  In  the  large 
cities  one-third  of  the  deaths  in  children  under  ten  years  of  age 
came  from  small  pox. 

Not  a  decade  passed  in  which  this  disease  did  not  decimate 
the  inhabitants  in  one  country  or  another,  or  over  great  tracts 
of  country,  so  that  it  came  to  be  more  dreaded  than  the  plague. 

These  facts  of  historv  give  some  idea  of  the  benefit  which  has 
been  conferred  upon  humanity  by  vaccination.  Without  the 
protection  which  it  affords,  nearly,  if  not  quite,  the  olden,  fear¬ 
ful  rate  of  mortality  would,  in  the  course  of  a  generation  or 
two,  be  restored. 

Cleanliness  and  the  observance  of  the  general  laws  of  health 
might  avail  a  little,  but  only  a  little,  in  restricting  the  disease, 
which  seems  to  have  its  being  always  in  infection. 

In  a  community  or  town  well  and  thoroughly  vaccinated  there 
would  be  no  possibility  of  a  serious  extension  of  small  pox. 
Neglect  of  this  protection  has,  even  in  recent  years,  sometimes 
led  to  very  disastrous  and  unprofitable  results,  entailing  losses 
amounting  to  millions-  of  dollars  in  human  life  and  paralyzed 
business. 

The  all-important  preventive  measure  is  vaccination.  In  the 
face  of  the  disease,  vaccination,  isolation  and  disinfection 
must  go  hand  in  hand. 

Vaccination. — Every  child  should  be  vaccinated  in  its  earliest 
years,  preferably  before  six  months  of  age,  and  in  case  of 
danger  of  infection,  the  vaccination  should  be  done  at  once,  no 
matter  how  voung  the  child  is.  Vaccination  should  be  done 

t  O 


11 


again  before  puberty,  and  better  before  ten  or  twelve  years  of 
age.  Afterwards  vaccination  should  be  tried  as  often  as  every 
six  or  seven  years,  or  oftener  if  the  person  is  subjected  to  prob¬ 
able  danger  of  small  pox  contagion. 

Vaccination  should  be  done  only  by  competent  physicians, 
and  only  with  vaccine  virus  of  undoubted  reliability  and  purity, 
otherwise  a  sense  of  security  is  often  felt  when  in  fact  protec¬ 
tion  is  not  obtained. 

In  the  performance  of  this  operation,  scrupulous  cleanliness 
in  all  respects  should  be  observed,  the  skin  of  the  selected  site 
should  be  made  aseptic,  and  the  virus  used  should  be  of  known 
good  quality. 

No  blood  should  be  drawn  in  the  process,  only  the  superficial 
layer  of  the  skin  being  removed  until  an  oozing  of  serum  ap¬ 
pears,  and  insertions  of  virus  carefully  worked  in  should  be 
made  in  two  or  three  places  as,  by  so  doing,  the  chances  of 
successful  inoculation  are  increased,  and  experience  has  shown 
the  enhanced  protection  afforded  by  multiple  scars  of  a  genuine 
character. 

In  case  of  the  presence  of  small  pox,  immediate  and  careful 
vaccination  should  be  made  of  all  persons  who  have  not  recently 
been  so  protected.  Even  after  known  exposure  to  the  disease, 
vaccination  should  be  done  any  time  before  the  actual  appear¬ 
ance  of  the  eruption.  If  done  within  two  or  three  days  after 
exposure  it  will  often  prevent  the  disease,  or  make  it  much 
lighter;  and  done  later,  there  is  reason  to  believe  that  even  then 
it  has  a  salutary  effect  upon  the  course  of  the  disease. 

Isolation  or  Quarantine. — When  a  case  appears,  enforce 
immediately  strict  isolation  and  quarantine  of  the  patient,  and 
this  should  be  continued  for  at  least  two  weeks  after  the  recovery 
of  the  case  and  after  the  crusts  have  all  separated.  When  the 
patient  cannot  be  removed  to  a  hospital,  but  must  remain  in  a 
private  house,  secure  a  room,  if  possible,  on  the  uppermost  floor, 
and  remove  from  it  all  articles  and  furnishings  which  will  not 
absolutely  be  needed.  For  a  nurse  have  some  person  who  has 
been  recently  and  successfully  vaccinated,  or  who  has  had  small 
pox.  Keep  all  others  away  from  the  room.  All  other  persons 
in  the  house  and  neighborhood  should  immediately  be  vaccinated. 
In  case  of  death  the  funeral  should  be  strictly  private,  and  con- 


12 


ducted  in  such  manner  under  the  regulations  of  the  Department 
as  will  insure  no  danger  to  the  public. 

Disinfection. — The  disinfection  should  also  be  done  under 
the  same  authority.  During  the  sickness  all  discharges  from 
the  patient  should  be  plentifully  treated  with  disinfectant  solu¬ 
tions  of  chlorine  or  carbolic  acid  before  bein£  thrown  into  the 
sewer.  All  crusts  should  be  burned. 

Clothing  should  be  subjected  to  steam  or  sulphur  disinfection, 
or  immersed  in  disinfectant  solutions,  or  subjected  to  prolonged 
boiling.  All  articles  which  cannot  be  surely  disinfected  must 
be  burned. 

If  death  should  occur,  the  body  should  be  immediately  wrapped 
in  a  sheet  wet  with  strong  bichloride  of  mercury  or  carbolic 
acid  solutions,  and  prepared  as  soon  as  possible  for  private 
burial. 

The  room  and  house  should  be  very  thoroughly  fumigated 
with  sulphur  or  chlorine  vapors,  and  renovated  with  paper,  paint 
and  whitewash. 


TYPHOID  FEVER. 

The  specific  cause  of  typhoid  fever  has  been  found  in  the  air, 
drinking  water  defiled  with  decomposing  organic  matter  and 
particularly  Avith  emanations  from  sewage.  The  poison  of 
typhoid  fever  finds  its  way  into  wells,  cisterns,  drains  and  sewers 
by  means  of  the  dejections  of  persons  ill  of  the  disease.  A 
single  case  may,  in  this  manner,  give  rise  not  only  to  other 
cases,  but  even  to  extensive  epidemics.  Defective  water  closets 
or  leaking  drain  pipes  should  be  carefully  attended  to. 

Typhoid  fever  is  pre-eminently  an  endemic  disease,  but  may 
become  epidemic  if  proper  sanitary  precautions  are  neglected. 
The  greatest  care  should  be  observed  in  the  disposition  of  the 
discharges  from  the  bowels  of  typhoid  fever  patients. 


13 


Recommendations. 

Boil  all  water  used  for  drinking  purposes. 

Boil  and  sterilize  or  Pasteurize  milk. 

Examine  all  the  plumbing  of  the  house  and  remedy  the 
defects. 

Thoroughly  disinfect  all  closets  and  vaults. 

Promptly  remove  all  dejections  from  patients. 

Avoid  washing  clothing  of  patient  with  typhoid  fever  in  con¬ 
nection  with  other  clothes. 

General  contact  with  patient  should  be  confined  only  to  nurse 
and  doctor. 

Vessels  from  which  patients  drink  should  not  be  used  by  any 
other. 


Disinfection  Solutions  Recommended. 

For  Clothing,  Towels,  Napkins  and  Sheets. — Dissolve 
corrosive  sublimate  in  water  in  the  proportion  of  four 
ounces  to  the  gallon,  and  add  one  drachm  of  permanganate 
of  potash  to  give  color  to  the  solution  as  a  precaution  against 
poisoning.  One  fluid  ounce  of  this  solution  to  the  gallon  of 
water  is  sufficiently  strong ;  articles  should  be  left  in  it  for  two 
hours. 

For  the  Disinfecting  of  Water  Closets,  Sinks  and  Cess 
Pools. — Mix  one  pint  of  carbolic  acid  in  two  gallons  of  hot 
water  in  which  there  has  been  dissolved  one  quart  of  copperas. 
Sprinkle  dry  chloride  of  lime  in  privies. 

After  a  case  of  typhoid  fever  has  terminated,  the  premises 
should  be  thoroughly  disinfected  by  the  Health  Department; 
this  will  be  done  whenever  the  request  is  made,  free  of  charge. 

Typhoid  fever  is  considered  a  dangerous  communicable  dis¬ 
ease,  and  as  such,  comes  under  the  class  of  diseases  that 
physicians  are  required  by  law  to  report  to  the  Health  Com¬ 


missioner. 


14 


General  Rules  for  the  Prevention  and  Restriction  of 

COMMUNICABLE  DISEASES. 

1.  Avoid  the  contagium  or  special  cause  of  the  disease. 
Unless  you  are  needed  to  care  for  the  sick,  or  are  protected  by 
having  had  the  disease,  or  in  case  of  small  pox  by  thorough 
vaccination,  do  not  go  near  the  sick  person.  Do  not  allow  your 
lips  to  touch  any  food,  cup,  spoon  or  anything  else  that  the  sick 
person  has  touched  or  that  has  been  in  the  sick  room.  Do  not 
wipe  your  face  or  hands  with  any  cloth  that  has  been  near  the 
sick  person.  Do  not  wear  any  clothing  that  the  sick  person  has 
worn  during,  just  before  or  just  after  his  sickness.  Keep  your 
hands  free  from  discharges  from  the  body  or  skin  of  the  sick 
person.  Do  not  touch  him  with  sore  or  scratched  hands.  Par¬ 
ticularly  avoid  inhaling  or  in  any  way  receiving  into  the  mouth 
or  nose  the  branny  scales  that  fall  or  peel  from  one  recovering 
from  or  apparently  wholly  recovered  from  scarlet  fever. 

2.  Restrict  the  contagium  or  special  cause  of  disease. 
Isolate  the  sick.  Separate  those  sick  with  any  of  these  diseases, 
even  if  they  are  but  mildly  sick,  from  all  persons  except  neces¬ 
sary  attendants.  A  person  sick  with  any  of  these  diseases 
should  not  be  permitted  to  suffer  for  want  of  care,  food  or  com¬ 
fort ;  but  all  his  wants  should  be  attended  to  by  adults,  or  by 
those  who  are  protected  by  proper  vaccination  or  by  having  had 
the  disease.  Children  and  those  who  are  not  thus  pro¬ 
tected  should  be  kept  away  from  these  diseases.  Do  not 
go  from  the  sick  room  to  a  child  or  other  unprotected 
person  until  after  change  of  clothing  and  thorough  wash¬ 
ing  of  hands,  face,  hair  or  beard.  Always  wash  the 
hands  thoroughly  after  any  handling  of  the  sick  person  or  of 
anything  that  has  been  in  contact  with  the  sick  person.  Keep 
those  who  have  been  exposed  to  any  of  these  diseases  away  from 
schools,  churches  and  other  assemblies,  and  from  all  children, 
until  it  is  known  whether  they  are  infected;  and  if  they  are 
found  to  be  infected,  isolate  them  till  after  complete  recovery 
and  thorough  disinfection. 

3.  Keep  your  house  and  premises  and  everything  connected 
therewith  clean,  but  remember  that  the  contagium  of  these  dis- 


15 


eases  may  attach  to  the  cleanest  article  of  clothing,  food,  drink, 
book  or  paper  if  it  is  exposed  thereto. 

When  the  death  of  a  person  who  has  died  from  scarlet  fever, 
diphtheria  or  small  pox  is  announced  in  print,  the  notice  should 
state  the  cause  as  “from  scarlet  fever, ’*  diphtheria  or  small  pox, 
as  the  case  may  be,  to  prevent  attendance  at  the  funeral  or  visits 
to  the  house  by  persons  liable  to  take  the  disease. 


Provisions  and  Requirements  of  Law 

RESPECTING  THE  DUTIES  OF 

PHYSICIANS 

WHEN  IN  ATTENDANCE  UPON  A  CASE  OR  CASES  OF 

COMMUNICABLE  DISEASE. 

[17,186.] 

An  Ordinance  in  relation  to  the  reporting  of  contagious,  in¬ 
fectious  and  pestilential  diseases,  and  to  repeal  section  three 
hundred  and  sixty-one,  article  eight,  chapter  fourteen,  of  the 
Kevised  Ordinances  of  eighteen  hundred  and  eighty-seven. 

Be  it  ordained  by  tlie  Municipal  Assembly  of  the  City  of  St. 

Louis,  as  follows: 

Section  1.  It  shall  be  the  duty  of  each  and  every  practicing 
physician  of  the  City  of  St.  Louis  to  immediately  report  to  the 
Health  Commissioner  of  the  city  each -case  of  small  pox,  typhus 
fever,  croup,  cerebro-spinal  fever,  diphtheria,  erysipelas,  mea¬ 
sles,  puerperal  fever,  scarlatina,  typhoid  fever,  yellow  fever, 
whooping  cough,  cholera  and  chicken-pox  which  he  may  see 
or  be  called  upon  to  attend  within  the  limits  of  the  city. 

Sec.  2.  In  reporting  cases  of  contagious,  infectious  or  pes¬ 
tilential  diseases,  the  physician  shall  be  required  to  give  the 
name  and  residence  (street  and  number),  age  and  color,  of  each 


case. 


16 


Sec.  3.  In  cases  of  typhus  fever,  small  pox,  diphtheria, 
scarlatina  and  cholera,  where  the  house  is  not  placarded  within 
thirty-six  hours  after  the  first  report,  duplicate  report  must  be 
made. 

Sec.  4.  Whenever  any  case  of  diphtheria,  scarlatina,  chol¬ 
era,  typhus  fever,  typhoid  fever,  small  pox  and  cerebro-spinal 
fever  has  terminated,  and  there  are  no  other  cases  in  the  same 
house,  the  physician  last  attending  such  cases  shall  report  im¬ 
mediately  the  fact  to  the  Health  Commissioner,  so  said  prem¬ 
ises  may  be  disinfected. 

Sec.  5.  Any  physician  violating  any  of  the  provisions  of 
this  ordinance,  or  failing  to  perform  the  duties  required  of  him 
by  this  ordinance,  shall  be  deemed  guilty  of  a  misdemeanor, 
and  upon  conviction  shall  be  fined  not  less  than  fifty  nor  more 
than  two  hundred  and  fifty  dollars,  to  be  recovered  for  the  use 
of  the  City  of  St.  Louis  before  any  court  having  competent 
jurisdiction. 

Sec.  6.  The  Health  Commissioner  shall  furnish  the  proper 
blank  form  on  which  to  make  the  reports,  as  required  by  this 
ordinance. 

Sec.  7.  Section  three  hundred  and  sixty-one,  of  article 
eight,  chapter  fourteen,  of  the  Kevised  Ordinances  of  eighteen 
hundred  and  eighty-seven  is  hereby  repealed. 

0 

Approved  April  1st,  1893. 

Only  houses  in  which  there  is  Small  Pox,  Cholera,  Diph¬ 
theria,  Scarlatina,  Croup,  or  Cerehro- Spinal 
Fever  will  he  placarded. 

N.  B. — Every  case  occurring  in  the  same  family  must  he 

reported. 


17 


Provisions  and  Requirements  of  Law 

RESPECTING  THE  DUTIES  OF 

• 

The  Managers  and  Principals  of  Public,  Private  and 
Parochial  Schools  of  the  City  of  St.  JLouis. 

That  in  order  to  check  the  spread  of  contagious  diseases  the 
Health  Commissioner  strongly  recommends  to  all  superintendents 
and  managers  of  public,  private  and  parochial  schools,  the  strict 
enforcement  of  Secs.  381  and  382,  Art.  9,  Chap.  14,  Rev.  Old. 
1893 ;  and  he  also  recommends  the  adoption  by  all  managers  of 
schools  of  the  following  rules  for  the  government  of  schools 

o  o 

under  their  charge : 

O 


Regulations  in  Regard  to  Small  Pox,  Diphtheria,  Scarlatina, 
Measles,  Whooping  Cough,  Chicken  Pox, 
Erysipelas  and  Croup. 

Section  1.  When  any  member  of  a  family  is  afflicted  with 
any  of  the  above  named  diseases,,  all  children  of  that  family, 
and  all  children  living  in  the  same  house,  must  be  excluded  from 
school. 

Sec.  2.  When  two  or  more  families  use  in  common  the 
same  entrance  to  a  building,  or  the  same  yard,  or  the  same  water 
closet,  or  the  same  vault,  all  children  of  such  families  must  be 
excluded  from  school,  in  case  any  member  of  one  of  these  fami¬ 
lies  is  afflicted  with  any  of  the  above  named  diseases. 

Sec.  3.  Children  who  have  been  excluded  from  school,  under 
the  above  conditions,  for  small  pox,  croup,  cerebro-spinal  fever, 
diphtheria,  or  scarlatina,  shall  be  reinstated  only  upon  a  certifi¬ 
cate  of  the  Chief  Sanitary  Officer  of  the  Health  Depart¬ 
ment  that  the  case  or  cases  in  that  locality  have  terminated,  and 
that  the  premises  where  the  diseases  have  existed  have  been 
thoroughly  fumigated  by  the  Health  Department. 

Sec.  4.  Children  who  have  been  excluded  from  school,  under 
the  above  conditions,  for  Measles,  Whooping  Cough,  Chicken 
Pox  or  Erysipelas,  may  return  upon  the  certificate  of  the 
attending  physician  that  the  child  is  well. 


18 


Sections  381  and  382,  Art.  9,  Chap.  14,  Rev.  Ord.  1893,  as 
follows : 

Section  381.  The  parents  or  guardians  of  children  attend¬ 
ing  any  private  or  public  school,  who  shall  permit  them  to 
attend  school  after  it  becomes  known  to  said  parents  or  guardi¬ 
ans  that  any  of  their  family  are  infected  with  any  infectious  or 
contagious  disease ,  shall  be  deemed  guilty  of  a  misdemeanor, 
and  upon  conviction  thereof,  shall  be  fined  in  a  sum  of  not  less 
than  five  nor  more  than  ten  dollars. 

Sec.  382.  Any  principal  or  teacher  of  any  private  or  public 
school  in  the  City  of  St.  Louis  having  official  or  authentic 
information  of  the  existence  of  any  infectious  or  contagious 
disease  in  the  family  of  any  pupil  attending  said  school,  shall 
immediately  cause  the  removal  of  said  pupil  from  said  school, 
and  until  lie  (or  she)  shall  have  undoubted  proof  of  the  premises 
where  the  family  reside  being  disinfected  and  the  disease 
eradicated.  Any  failure  on  the  part  of  any  principal  or  teacher 
complying  with  the  provisions  of  this  article  shall  be  deemed 
guilty  of  a  misdemeanor,  and  upon  conviction  thereof,  shall  be 
fined  in  a  sum  not  less  than  five  nor  more  than  ten  dollars. 

The  Health  Commissioner  strongly  recommends  that  all 
premises  in  which  there  has  been  Diphtheria,  Croup,  Cerebro¬ 
spinal  Fever,  Scarlatina,  Measles,  Small  Pox  or  Consumption, 
be  thoroughly  disinfected  on  the  termination  of  each  case. 

The  Health  Commissioner  also  recommends  that  the  funerals 
of  all  persons  dying  of  Small  Pox,  Diphtheria,  Croup  or  Scarla¬ 
tina,  be  private,  and  that  on  no  account  shall  the  placards 
placed  on  the  houses  by  order  of  the  Health  Commissioner  be 
removed  until  the  person  is  well  or  the  funeral  has  taken  place 
and  the  premises  fumigated. 

All  premises  will  be  fumigated  free  of  charge  upon  applica¬ 
tion  to  the  Health  Commissioner. 

Section  379,  Article  9,  Chapter  14,  of  the  Ordinances  of  the 
City  of  St.  Louis. 

Section  379.  Whenever  any  physician  shall  report  to  the 
Health  Commisioner  any  case  of  small  pox  or  contagious  disease 
in  any  dwelling  or  building  in  the  City  of  St.  Louis,  the  Health 
Commissioner  shall  have  the  power,  whenever  in  his  opinion  it 


is  necessary,  to  cause  to  be  placed  on  the  outside  of  any  build¬ 
ing  or  dwelling  or  door  of  any  room,  a  printed  placard,  giving 
notice  of  the  existence  of  such  contagious  disease.  Any  person 
who  shall  remove  such  placard,  placed  by  order  of  the  Health 
Commissioner,  shall  be  deemed  guilty  of  a  misdemeanor,  and 
upon  conviction  be  fined  not  less  than  five  nor  more  than  twenty- 
five  dollars. 

The  placard  must  remain  until  the  premises  have  been  disin¬ 
fected  by  the  Health  Department. 

MAX  C.  STARKLOFF,  M.  D., 

Health  Com missioner . 


November  20,  1895. 


